Friday, January 05, 2018

Hyponatremia in heart failure

In this study
most heart failure patients with hyponatremia on admission were
discharged hyponatremic. Among treatment approaches fluid
restriction was most common. No deliberate attempt to lower serum
sodium ranked second. Despite heavy promotion hardly anybody used
tolvaptan.

From the Clinical
Perspective portion of the paper:

Clinical Perspective

What Is New?

Hyponatremia
(HN) is common in patients hospitalized with acute heart failure and
is associated with worse outcomes.

We examined
current practices for the management of HN in 762 patients with acute
heart failure.

Fluid
restriction was the most commonly used strategy for correcting HN;
however, nearly one quarter received no specific therapy.

What Are the
Clinical Implications?

Most patients
with HN remained hyponatremic at discharge.

Further studies
are needed to determine optimal approaches to effectively correct HN
the inpatient setting.

The last sentence
above reflects the wrong perspective. Hyponatremia is indeed a
predictor of worse outcomes but not as a result of the sodium
concentration itself. Rather, it is because it is a marker of
neurohumeral activation. Antagonizing the neurohumeral response has
been the focus of treatment of systolic heart failure for decades.
One class of neurohumeral antagonists, the aldostone receptor
antagonists, has the effect of lowering serum sodium.